1326090382 NPI number — VICKI CARONNA THIEL FNP

Table of content: VICKI CARONNA THIEL FNP (NPI 1326090382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326090382 NPI number — VICKI CARONNA THIEL FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIEL
Provider First Name:
VICKI
Provider Middle Name:
CARONNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326090382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4228 HOUMA BLVD
Provider Second Line Business Mailing Address:
STE 410
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-883-3770
Provider Business Mailing Address Fax Number:
504-883-3711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4228 HOUMA BLVD
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
METAIRLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-883-3770
Provider Business Practice Location Address Fax Number:
504-883-3711
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN0403173125 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP03125 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1550680 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com